Gestión humana y desempeño de los enfermeros para la atención de pacientes con VIH/SIDA / Human management and performance of nurses for the care of patients with HIV/AIDS

En los centros hospitalarios con atención de pacientes VIH/SIDA se requiere de una gestión humana que promueva un buen desempeño laboral del personal de enfermería para proveer una buena calidad de atención. Como objetivo se desarrolló una revisión sistemática sobre la gestión humana y el desempeño de los enfermeros para la atención de pacientes con VIH/SIDA. El estudio fue descriptivo, con una muestra de 52 artículos resultantes de la aplicación de criterios de exclusión, las fuentes de datos utilizadas fueron: ScienceDirect, ProQuest, PubMed, Taylor &Francis Online y EBSCO Host; se incluyó la búsqueda de palabras claves como: desempeño laboral de enfermeros/ trabajo de los enfermeros/ Gestión del talento humano, Método/ Metodología/ Modelo y Pacientes con VIH/ pacientes con SIDA. Como resultado, Las métricas de gestión del talento humano en el desempeño laboral de los enfermeros para la atención de pacientes con VIH/SIDA estuvieron representadas con 29% "satisfacción laboral", 17% "formación y desarrollo/ entrenamiento", 17% "entrenamiento", 15% "rotación", 15% "rendimiento", 12% "retención" y 10% "equipo de trabajo", entre las labores que desempeña el personal de enfermería, estuvieron monitoreo de signos vitales, ejecución y asistencia de procedimientos, administración de medicamentos, planificación de consultas, la ayuda al paciente, seguimiento de la evolución o involución, preservación de la seguridad, monitoreo de los acontecimientos y promoción de la salud sexual y reproductiva. Es necesario continuar con estudios investigativos que promuevan la gestión humana dentro de los centros hospitalarios y la atención de enfermería a los pacientes con cualquier patología infectocontagiosa(AU)

In hospital centers that care for HIV/AIDS patients, a human management is required that promotes a good job performance of the nursing staff to provide a good quality of care. As an objective, a systematic review on human management and the performance of nurses for the care of patients with HIV/AIDS was implemented. The study was descriptive, with a sample of 52 articles resulting from the application of exclusion criteria. The data sources used were: ScienceDirect, ProQuest, PubMed, Taylor & Francis Online, and EBSCO Host; It includes the search for keywords such as: job performance of nurses / work of nurses / Management of human talent, Method / Methodology / Model and Patients with HIV / patients with AIDS. As a result, the human talent management metrics in the job performance of nurses for the care of patients with HIV/AIDS were represented with 29% "job satisfaction", 17% "training and development/training", 17% "training ", 15% "rotation", 15% "performance", 12% "retention" and 10% "work team", among the tasks carried out by the nursing staff, were monitoring of vital signs, execution and assistance of procedures, medication administration, consultation planning, patient assistance, follow-up of the evolution or involution, preservation of safety, monitoring of events and promotion of sexual and reproductive health. It is necessary to continue with research studies that promote human management within hospital centers and nursing care for patients with any infectious disease(AU)

Postoperative respiratory failure after cardiac surgery: use of noninvasive ventilation.

OBJECTIVES: To analyze the use of noninvasive ventilation (NIV) in respiratory failure after extubation in patients after cardiac surgery, the factors associated with respiratory failure, and the need for reintubation. DESIGN: Retrospective observational study. SETTING: Intensive care unit in a university hospital. PARTICIPANTS: Patients (n = 63) with respiratory failure after extubation after cardiac surgery over a 3-year period. INTERVENTIONS: Mechanical NIV. MEASUREMENTS AND MAIN RESULTS: Demographic and surgical data, respiratory history, causes of postoperative respiratory failure, durations of mechanical ventilation and spontaneous breathing, gas exchange values, and the mortality rate were recorded. Of 1,225 postsurgical patients, 63 (5.1%) underwent NIV for respiratory failure after extubation. The median time from extubation to the NIV application was 40 hours (18-96 hours). The most frequent cause of respiratory failure was lobar atelectasis (25.4%). The NIV failed in 52.4% of patients (33/63) who had a lower pH at 24 hours of treatment (7.35 v 7.42, p = 0.001) and a higher hospital mortality (51.5% v 6.7%, p = 0.001) than those in whom NIV was successful. An interval <24 hours from extubation to NIV was a predictive factor for NIV failure (odds ratio, 4.6; 95% confidence interval, 1.2-17.9), whereas obesity was associated with NIV success (odds ratio, 0.22; 95% confidence interval, 0.05-0.91). CONCLUSIONS: Reintubation was required in half of the NIV-treated patients and was associated with an increased hospital mortality rate. Early respiratory failure after extubation (≤24 hours) is a predictive factor for NIV failure.

Pandemic and post-pandemic influenza A (H1N1) infection in critically ill patients.

BACKGROUND: There is a vast amount of information published regarding the impact of 2009 pandemic Influenza A (pH1N1) virus infection. However, a comparison of risk factors and outcome during the 2010-2011 post-pandemic period has not been described. METHODS: A prospective, observational, multi-center study was carried out to evaluate the clinical characteristics and demographics of patients with positive RT-PCR for H1N1 admitted to 148 Spanish intensive care units (ICUs). Data were obtained from the 2009 pandemic and compared to the 2010-2011 post-pandemic period. RESULTS: Nine hundred and ninety-seven patients with confirmed An/H1N1 infection were included. Six hundred and forty-eight patients affected by 2009 (pH1N1) virus infection and 349 patients affected by the post-pandemic Influenza (H1N1)v infection period were analyzed. Patients during the post-pandemic period were older, had more chronic comorbid conditions and presented with higher severity scores (Acute Physiology And Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA)) on ICU admission. Patients from the post-pandemic Influenza (H1N1)v infection period received empiric antiviral treatment less frequently and with delayed administration. Mortality was significantly higher in the post-pandemic period. Multivariate analysis confirmed that haematological disease, invasive mechanical ventilation and continuous renal replacement therapy were factors independently associated with worse outcome in the two periods. HIV was the only new variable independently associated with higher ICU mortality during the post-pandemic Influenza (H1N1)v infection period. CONCLUSION: Patients from the post-pandemic Influenza (H1N1)v infection period had an unexpectedly higher mortality rate and showed a trend towards affecting a more vulnerable population, in keeping with more typical seasonal viral infection.

Community-acquired respiratory coinfection in critically ill patients with pandemic 2009 influenza A(H1N1) virus.

BACKGROUND: Little is known about the impact of community-acquired respiratory coinfection in patients with pandemic 2009 influenza A(H1N1) virus infection. METHODS: This was a prospective, observational, multicenter study conducted in 148 Spanish ICUs. RESULTS: Severe respiratory syndrome was present in 645 ICU patients. Coinfection occurred in 113 (17.5%) of patients. Streptococcus pneumoniae (in 62 patients [54.8%]) was identified as the most prevalent bacteria. Patients with coinfection at ICU admission were older (47.5±15.7 vs 43.8±14.2 years, P<.05) and presented a higher APACHE (Acute Physiology and Chronic Health Evaluation) II score (16.1±7.3 vs 13.3±7.1, P<.05) and Sequential Organ Failure Assessment (SOFA) score (7.0±3.8 vs 5.2±3.5, P<.05). No differences in comorbidities were observed. Patients who had coinfection required vasopressors (63.7% vs 39.3%, P<.05) and invasive mechanical ventilation (69% vs 58.5%, P<.05) more frequently. ICU length of stay was 3 days longer in patients who had coinfection than in patients who did not (11 [interquartile range, 5-23] vs 8 [interquartile range 4-17], P=.01). Coinfection was associated with increased ICU mortality (26.2% vs 15.5%; OR, 1.94; 95% CI, 1.21-3.09), but Cox regression analysis adjusted by potential confounders did not confirm a significant association between coinfection and ICU mortality. CONCLUSIONS: During the 2009 pandemics, the role played by bacterial coinfection in bringing patients to the ICU was not clear, S pneumoniae being the most common pathogen. This work provides clear evidence that bacterial coinfection is a contributor to increased consumption of health resources by critical patients infected with the virus and is the virus that causes critical illness in the vast majority of cases.